Cut Your Stroke Risk

Stroke is the most preventable cause of death and disability in the US. yet more than 750,000 Americans experience strokes each year...approximately 160,000 of these people die .. .and 200,000 live with lasting disability. What are we doing wrong?

You can't change some risk factors, such as family history. If you have a parent or sibling who has had a stroke, you are at greater risk yourself. Your age also plays a role. While strokes can occur even in young children, overall risk steadily increases as we grow older. That's why more than two-thirds of strokes occur in people older than age 65.

Beyond these factors, whether we have a stroke is largely up to us.

Stroke Prevention

What most affects stroke risk...

Smoking. Everyone knows that smoking increases heart disease risk, but did you know that smoking is actually more likely to cause a stroke than a heart attack? Not only does smoking promote the development of fatty deposits that narrow arteries (atherosclerosis), but the nicotine in tobacco causes blood vessels in the brain to constrict.

Result: Smokers have up to a four times greater risk of stroke than nonsmokers.

What you can do: Quit smoking. If you've tried but can't kick the habit, consider using nicotine-replacement patches or gum...or the prescription drug bupropion (Zyban).

Blood pressure. High blood pressure gradually damages blood vessels and substantially increases the risk for both ischemic and hemorrhagic strokes. The risk is greater because high blood pressure rarely causes symptoms, so the problem goes unrecognized in 30% of people who have hypertension.

What you can do: If your blood pressure is higher than 120/8O, take steps to reduce it. Weight loss and exercise may be enough, but you also may need medication, such as diuretics or beta blockers.

Cholesterol. To prevent a stroke, maintain the same cholesterol levels that are recommended to reduce heart disease risk-total cholesterol less than 200...LDL ("bad') cholesterol less than 100...HDL ('good') cholesterol greater than 40.

What you can do: Weight loss and exercise help control cholesterol levels. If these strategies are not sufficient, cholesterol-lowering medication may be needed.

Diabetes. Maintaining tight control of blood sugar (glucose) will minimize small blood vessel damage that can lead to stroke.

What you can do: With your doctor, create a treatment plan that keeps your hemoglobin AlC (blood sugar over time) level at less than 7.

Diet. Stroke risk, like heart disease risk, can be related to diet.

What you can do: Maintain a diet that's low in saturated fats (no more than 30% of total fats per day) and high in fruits and vegetables (five to nine one-half cup servings per day).

Research shows that people who are deficient in potassium arc 1.5 to 2.5 times more likely to have a stroke. Aim for the government's recommended potassium intake of 4,700 milligrams (mg) daily. Although bananas are a popular source of potassium (one medium banana contains 457 mg of potassium), cantaloupe can be an even richer source (one cup of cantaloupe balls contains approximately 547 mg)

If you determine that sodium raises your blood pressure, limit your daily sodium intake to 2.4 grams (g) (slightly more than one teaspoon of salt).

Exercise. Physical activity reduces the risk of heart disease, diabetes and hypertension and may offer stroke protection as well.

What you can do: Work with your doctor to create an exercise program based on your history of heart disease, smoking, etc.

Daily aspirin. Aspirin reduces the tendency of platelets to clump, which helps prevent blood clots that can lead to ischemic stroke.

What you can do: If you're older than 55 and have diabetes, high cholesterol or other stroke risk factors, ask your doctor about starting daily low-dose (81-mg) aspirin therapy. In patients who have never had a stroke or heart attack, and who do not have hypertension, diabetes or elevated cholesterol, the risk of hemorrhage may outweigh the potential benefits of aspirin.

Alcohol. Moderate alcohol consumption has been shown to benefit the heart, but it does not curb stroke risk.

What you can do: Men should limit their alcohol intake to two drinks per day...one drink per day for women. A drink is defined as 1.5 ounces of hard liquor, 4 ounces of wine or 12 ounces of beer. The risk of hemorrhagic stroke jumps substantially if you exceed this amount.

Other Risk Factors

Some medical conditions significantly raise your stroke risk...

Atrial fibrillation. Approximately 2.2 million Americans are affected by atrial fibrillation (AF), a heart rhythm disturbance that increases stroke risk five- to six fold.

AF can cause dizziness, shortness of breath, constriction or other uncomfortable sensations in the chest. Or it may cause no symptoms and be found during a routine examination or when you have an electrocardiogram.

What you can do: Taking a blood-thinning drug, such as warfarin (Coumadin), can virtually eliminate AF's added stroke risk by preventing the formation of blood clots. Aspirin may be nearly as effective.

Transient ischemic attack (TIA). if you have had one or more of these brief stroke like episodes, your risk for a full-blown stroke increases dramatically. A TIA can cause dizziness, numbness or paralysis on one side of the body, difficulty speaking, double vision or other stroke symptoms that disappear after minutes or hours.

What you can do: After a TIA, ask your doctor about taking antiplatelet medication, such as aspirin, clopidogrel (Plavix) or dipyridamole along with aspirin (Aggrenox).

Carotid stenosis. When fatty deposits accumulate in the carotid artery which carries blood up through the neck, they can impede brain circulation enough to cause a stroke' Up to half of all ischemic strokes are associated with carotid stenosis.

What you can do: If you have had a stroke or TIA, get an ultrasound of your carotid artery If this artery is at least 70% blocked, ask your doctor about surgery.